The value of the first postoperative diagnostic I-131 scan in patients with papillary thyroid carcinoma.

OBJECTIVE: To explore the feasibility of the postoperative diagnostic 131I whole-body planar scans (Dx-WBS) in papillary thyroid cancer (PTC) patients, and to clarify its value for accurate staging, risk stratification, and postoperative radioactive iodine (RAI) treatment management. DESIGN: Retrospective study from 2015 to 2021. SETTING: A total of 1294 PTC patients in the tertiary referral hospital. PARTICIPANTS: Patients with differentiated thyroid cancer who underwent total/subtotal thyroidectomy were included. Patients with non-PTC pathological type, non-first RAI treatment, and incomplete data such as Dx-WBS and postablation WBS (Rx-WBS) were excluded. METHODS: The diagnostic efficacy of Dx-WBS was calculated with Rx-WBS as the reference. All patients were initially staged by the 8th edition of TNM staging, and risk stratification was performed based on clinical and pathological information. After Dx-WBS, the risk stratification was re-evaluated, and management was reconfirmed. RESULTS: The detection rates of Dx-WBS for residual thyroid, cervical lymph nodes, upper mediastinal lymph nodes, lung, and bone distant metastasis were 97.6%, 78.3%, 82.1%, 66.7%, and 61.2%, respectively. The risk stratification of 113 patients (8.7%) changed after Dx-WBS, of which 107 patients changed from low to intermediate risk, 2 from low to high risk, and 4 from medium to high risk. A total of 241 patients (18.6%) adjusted the RAI regimen after Dx-WBS. CONCLUSION: This study confirms the diagnostic efficacy of the postoperative Dx-WBS in PTC patients and the value of Dx-WBS in accurately assessing risk stratification, as well as assisting in determining RAI treatment.

Efficacy and safety of hepatic arterial infusion chemotherapy combined with lenvatinib and sequential ablation in the treatment of advanced hepatocellular carcinoma.

PURPOSE: Evaluate the efficacy and safety of triple therapeutic method (Hepatic Aarterial Infusion Chemotherapy-HAIC, lenvatinib and sequential ablation) in the treatment for Advanced Hepatocellular carcinoma (Ad-HCC). MATERIALS AND METHODS: From November 2018 to June 2021, data from 150 consecutive Ad-HCC patients were collected. All patients received HAIC combined with lenvatinib (H-L group, n = 97) or HAIC combined with lenvatinib and sequential ablation (H-L-A group, n = 53). Complications, overall survival (OS), progression-free survival (PFS) and intrahepatic progression-free survival (IPFS) were compared between both groups. RESULTS: No significant differences of baseline characteristics were found between groups. The time of median follow-up was 17.8 months (range, 6.8, 37.6 months). In comparison to the H-L group, the H-L-A group patients showed significantly longer median OS (>30 months vs 13.6 months, respectively; p = 0.010), PFS (12.8 vs. 5.6 months, respectively; p < 0.001), and IPFS (14.6 vs. 6.8 months, respectively; p = 0.002). According to the results from uni- and multivariable analyses, we considered α-fetoprotein and treatment modality as two survival independent prognostic factors. No significant change of the complication incidences was observed between H-L group and H-L-A group (12.4% vs. 11.3%, p = 0.890). CONCLUSION: Compared to HAIC combined with lenvatinib only, HAIC combined with lenvatinib and sequential ablation was safer and more effective, improving survival outcomes of Ad-HCC patients. A prospective study will be designed validate the retrospective results.